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目的:对急性心肌梗死(AMI)患者进行随访调查,了解其远期预后情况,探讨影响AMI患者远期预后因素。方法:回顾性分析三家三甲医院2003年1月~2013年12月初次确诊的AMI患者4 887例,收集其病例资料和初次实验室检查结果,电话随访患者出院后的服药及临床转归。根据临床结局的不同,将患者分为预后良好组和预后不良组,探讨可能影响AMI患者远期预后的因素。结果:4 887例患者中,预后良好患者3 829例(78.4%);预后不良1 058例(21.6%),包括死亡116例,再发心肌梗死32例,心力衰竭910例。1预后不良组患者的性别,体质量,心率,收缩压水平,舒张压水平,左室舒张末内径(LVEDD),心肌钙蛋白T(c Tn T),脑钠尿肽(BNP),餐后2 h血糖(Ph2PG),低密度脂蛋白胆固醇(LDL-C),总胆固醇(TC)水平与预后良好组之间有显著性差异(P<0.05或P<0.01);2预后不良组患者的高血压病,糖尿病,慢性肺部疾病,心房颤动,恶性肿瘤的发生率均高于预后良好组,差异有统计学意义(P<0.05或P<0.01)。多变量Logistical回归分析显示影响长期预后的因素为LVEDD(OR=3.10,P<0.01,CI 2.83-186.44),LDL-C(OR=2.90,P<0.01,CI 2.08-156.87)。结论:增大的LVEDD,增高的LDL-C可能为影响AMI患者远期预后因素。
Objective: To investigate the long-term prognosis of patients with acute myocardial infarction (AMI) and investigate the long-term prognostic factors of AMI. Methods: A retrospective analysis of three top three hospitals in January 2003 to 4 887 cases in December 2013 initial diagnosis of AMI patients, collected clinical data and initial laboratory results, medication and clinical outcomes after hospital discharge telephone follow-up. According to the different clinical outcomes, the patients were divided into good prognosis group and poor prognosis group, to explore the factors that may affect the long-term prognosis of patients with AMI. Results: Among 4887 patients, 3 829 (78.4%) had a good prognosis; 1 058 (21.6%) had poor prognosis, including 116 deaths, 32 recurrent myocardial infarctions and 910 heart failure patients. In the poor prognosis group, gender, body mass, heart rate, systolic blood pressure, diastolic blood pressure, left ventricular diastolic diameter (LVEDD), cardiac troponin T (cTn T), brain natriuretic peptide (BNP) , with H 2 glucose (Ph2PG) low density lipoprotein cholesterol (LDL-C) total cholesterol (TC) between the horizontal and the good prognosis group significant difference (P <0.05 or P <0.01); 2 poor prognosis group of patients Hypertension, diabetes, chronic lung disease, atrial fibrillation, and malignant tumors were significantly higher than those with good prognosis (P <0.05 or P <0.01). Multivariate Logistical regression analysis showed that the factors influencing long-term prognosis were LVEDD (OR = 3.10, P <0.01, CI 2.83-186.44) and LDL-C (OR = 2.90, P <0.01, CI 2.08-156.87). Conclusions: Increased LVEDD and increased LDL-C may be the long-term prognostic factors in patients with AMI.